THERAPEUTIC RIDING EDUCATION/TRAINING: AN ITALIAN UNIVERSITY EXPERIENCE

Transcription

1 THERAPEUTIC RIDING EDUCATION/TRAINING: AN ITALIAN UNIVERSITY EXPERIENCE Prof. Anna Pasquinelli, Dr. Paola Allori, Prof. Massimo Papini, Institute of Child Neurology and Psychiatry, Department of Neurological and Psychiatric Science, University of Florence, Italy Various Authors (Nolt et al, 1994; Brown et al, 1994; Kluwer and Shulz, 1997; Brown and Tebay, 1999) and the FRDI itself recommend that TR Professionals should be "University trained", also because this is an indispensable premise for the official recognition of the professional figure and of the discipline itself by National Health-care and Legislative Bodies, and thus for its insertion among the services provided by the National Health Service. At present the training of TR personnel is provided mainly by Training Schools, since this is a young profession. Sociologists have demonstrated that a major objective of the young professions is that of managing to obtain University Courses. The official role of training professionals, indispensable as a guarantee of the seriousness and constant level of training, as well as recognition of the professional figure and thus of the discipline itself, is in fact the province of the University. Official university training allows a profession to establish itself with an official register, and to be recognized also by the health-care authorities. This guarantees recognition by the sociohealth organizations as well as the professional quality of the service offered, the self-confidence of the operators and financial coverage of the service. The training of operators for TR is a highly complex initiative, considering that: A) the disciplinary areas involved are at least 3: Equitation, Rehabilitation, Health-Care Sector; B) the specific professional skills to be acquired include a good knowledge, guided experience and acquisition of the operating techniques of at least 3 disciplines: Hippotherapy, Remedial/Educational Riding and Vaulting, Sport Riding. These techniques are indispensable requisites, since they constitute possible stages of the rehabilitation program (Papini 1996): TR provides a vital occasion for relating therapy and sport, and its three different branches can provide a path through which transition from Technical Rehabilitation * i.e. Hippotherapy, to Integrated * Types and phases of Rehabilitation: Technical Rehabilitation (R1) aims at reducing to a minimum, as far as possible, the disability. It consists of specific health-care techniques, in practice therapeutical, which are aimed at reducing as much as possible functional incompetence. Social Rehabilita tion (R2) aims at reducing the specific problems connected to the handicap. Since the handicap is the aspect of the disability which concerns the implications of personal identity, of family and social roles, Social Rehabilitation is therefore directed, especially during the childhood and adolescence 1

2 Rehabilitation, i.e. Remedial Educational Riding and Vaulting, and then Social Rehabilitation, i.e. Sport Riding, takes place. The three branches of TR can therefore be considered as three phases of the rehabilitative process, at least for the subjects in whom this is possible. (Pasquinelli and Papini, 1997); C) training must be adequate to allow operators to follow patients in a wide range of ages (from children to the elderly) affected by different disabilities, sensorial, mental and in most cases by multiple disabilities (polihandicap). Accordingly, the training staff must be composed of various professionals having competences in Equitation, Veterinary Science, various Medical Specializations and the Socio-Health Sector, Rehabilitation, etc., but having above all practical-scientific experience in TR. TR is in fact a multiprofessional discipline par excellence, integrating competences that must be possessed in part in all of the operators, although with due respect for their individual professional expertise. In this report we describe the organization of TR Education/Training carried out in Italy by the Chair of Child Neuropsychiatry, Department of Neurological and Psychiatric Science, University of Florence, in collaboration with the TR Section of the "Lapo" Association (National Association of TR) in response to the AA's request and in accordance with the teaching and research rehabilitative goals of the Chair of Child Neuropsychiatry. (Prof. Anna Pasquinelli is the Professor responsible for the TR program). A specific program for TR has been drawn up, as follows. From 1993 the University of Florence, as the Chair of Child Neuropsychiatry, began to take an interest in TR. As Child Neuropsychiatrists, our research in rehabilitation focuses on finding a methodology of Integrated Rehabilitation in which the aim of Technical Rehabilitation of disabilities is included and disguised as an activity regularly engaged in by normal people (the aim of Social Rehabilitation). The theoretical possibilities, and above all, the concrete opportunities of Integrated Rehabilitation are in reality quite limited. TR provides a vital opportunity for combining years, at the development of relationships. Integrated Rehabilitation consists of the translation of the stimulation brought about during Ph ysiotherapy or cognitive Rehabilitation into solicitations effected in non-health-care settings. It is characterized by all those methods in which the rehabilitative treatment of the disability (R1) is included and disguised in an activity regularly engaged in by normal people (R2), that is it consists of aspects of rehabilitation from types R1 and R2 (Papini, 1996). The Child Neurology and Psychiatry Department (in Italy it is called Neuropsychiatry) of the University of Florence is directed by Prof. Massimo Papini; we carry out Hospital activity for in-patients as well as out-patient service. In Tuscany we are the only public and University structure in Neuropsychiatry for child and adolescent. Located in our Department is the University Post-Graduate School in Child Neuropsychiatry. We also teach Child Neurology, Psychiatry and Rehabilitation at the Post-Graduate Schools in Neurology, Neurophysiology, Psychiatry, Paediatry, Audiology, at University Diploma Courses for Physiotherapists, Orthottists, Audiometrits and to the students of the Faculty of Medicine, Educational Sciences, Psychology. 2

3 therapy and sport and its three different "branches" can be considered phases of the rehabilitative process. THE TRAINING ACTIVITIES OF THE CHAIR OF CHILD NEUROPSYCHIATRY CONSIST BASICALLY OF 3 TYPES OF INITIATIVES. 1) ESTABLISHING AN AREA FOR DISCUSSION AND FURTHER STUDY, open to all Italian citizens interested in the discipline, regardless of their profession, experience and background. THE OBJECTIVE IS PROFESSIONAL GROWTH, regardless of the level of departure. The constitution by the Chair of an "ITALIAN STUDY GROUP ON TR" a multiprofessional group with scientific aims which meets 3-4 times a year. The principal activities of this group are:1) discussion of video recordings (VR) concerning dubious cases and methodological problems; 2) the creation of case files on the cases at the TR Centers; 3) the elaboration of Protocols for the assessment of results both from a neuropsychiatric perspective and from that of riding competence; 4) the commissioning of research on the various aspects relative to TR and to horses. 5) up-to date on TR in other Countries. This group, furthermore, plays a very important role in the interaction and exchange between various Centers and, at any rate, between all those people who are interested in TR. It is, in fact, the first and only Italian Study Group on TR. All of this has allowed the operators of the various TR Centers and the various professions interested in TR to meet one another, to confront one another, to enter into discussion, to have virtually continuous updating. This, along with their frequent participation in the specific training areas listed below, has substantially improved the quality of the service they offer, conferring on them ample credibility with the socio-health structures, the medical ones in particular. 2) CARRYING OUT TRAINING INITIATIVES USEFUL FOR DETERMINING THE PROFESSIONAL GROWTH OF PROFESSIONALS ALREADY OPERATING IN THIS FIELD (UNIVERSITY COURSES AND TRAINING): A) in 1995 and in 1996 the organization of 2 FREE MULTIDISCIPLINARY UNIVERSITY COURSES ON TR (that is outside of the official University Course program) in 3

4 Florence. These were theoretical/practical 6-day Courses and consisted of theoretical lessons, included extensive video documentation, concerning medical/rehabilitative techniques (with details about indications, methodology and evaluation of TR seen as a part of a global program of rehabilitation), and riding and practical experience of therapeutic riding at a TR Center. The professionals attending the Courses were health-care professionals, Therapeutic Riding professionals, Riding Instructors.The teachers were professionals both Italian and foreign in the health-care sector, such as Child Neuropsychiatrists, Psychiatrists, Orthopedists, Physiologists from the University and from the Community Services, from the field of rehabilitation, such as Physiotherapists and TR Therapists, and from the field of Riding, such as Riding Masters belonging to the highest degrees of Riding Instruction in Italy, and other personalities involved with horse's such as Veterinarians (the Deans of the Faculties of Veterinary Science at the Universities of Pisa and Sassari), etc. These Courses had multidisciplinary character and scientific objectives, as well as favoring the diffusion of TR and the multidisciplinary integration of the professionals involved in TR. B) From 1997 to today: collaboration o f the Chair of Child Neuropsychiatry to the annual multi-professional "THEORETICAL/PRACTICAL TRAINING IN TR" (100 hours; beginning level) organized by the TR Section of "Lapo" Association. Training is addressed to all those who are interested in acquiring theoretical/practical knowledge in the field of TR: professionals in the health-care area, in the TR sector, in the riding sector, and volunteer workers. The purpose of Training is that of providing an overview of methods of organizing and carrying out TR as regards programming, conducting and verifying, as well as aspects of practical implementation, with special attention to methodology. A predominant part of Training consists of practical activity at the TR Centers and subsequent analysis of the work carried out with individual subjects. Participants in Training are limited in number. Two groups will be formed with a maximum of 8 persons per group, in order to provide all the participants with direct experience in TR. The Training schedule consists of 2 weeks (week A and B) (40 hours for each one) for each group and 20 hours of personal training in a TR Center (Total: 100 hours): Week A: general and practical education in TR Week B: detailed study and verification with direct participation in conducting TR, video-recording and subsequent analysis of data. Final examination. On completion of the Training period a Certificate of Theoretical/Practical Training (Beginning 4

5 Level) will be issued with assessment of achievement. 3)CARRYING OUT TRAINING INITIATIVES DESIGNED TO PROVIDE MANAGERIAL COMPETENCE IN THE FIELD OF TR: A) From 1995 to today, a TRAINING COURSE IN TR FOR A POST-GRADUATE DEGREE IN CHILD NEUROPSYCHIATRY is offered.this is included within the Chair's teaching activities (Training Course in TR - "Subroutine in TR"). ORGANIZATION: in 1993 an official agreement was stipulated between the University and a TR Center (the TR Center "Elisa" in Florence). Three to five Physicians attending the Post-Graduate School and working at the Child Neurology and Psychiatry Insitute are selected on the basis of motivations having to do with both rehabilitation and riding. A Professor of the University Post-Graduate School who has already acquired experience in riding and in TR supervises the entire teaching program and organization. The Team at the TR Center is composed of a Riding Instructor specialized in TR, TR Therapists, and a University Professor of Child Neuropsychiatry, the same Professor who supervises the TR training program. Through this complex training program Child Neuropsychiatrists, whose acquired competence in TR is actualized whitin the sphere of the specific neurological, psychiatric and rehabilitative competence of our Specialization, are trained. It is also necessary to point out how the ongoing relationship with highly qualified structures in the rehabilitation field, such as those at the University, has produced a direct spin-off effect on the TR Center, with a more specific definition of methodologies and consequent improvement both on the neuromotor and psychological results. Significant improvement has also been noted in the relationship with the operators/referral centers and with the families with consequent positive consideration of TR and increase in referral from the former and constancy of participation and dramatic reduction in unscheduled interruption on the part of the latter. B) In A.Y. 1999/2000, 2000/2001 organization of a "UNIVERSITY ADVANCED COURSE IN TR: EDUCATION/TRAINING" (1 year, 700 hours) by the Faculty of Medicine and Surgery, Chair of Child Neuropsychiatry for Post-Graduate Professionals (University Diploma or Degree in Medicine, Social/Health Care Areas, Rehabilitation, Education, Motory Sciences, Veterinary Science) with issuing of an University certificate and 5

6 C) from 2002/2003 conversion of the aforesaid Course into "UNIVERSITY MASTER IN TR" (1 year, 550 hours, 84 Credits). The Course is organized by the University of Florence, Faculty of Medicine and Surgery, Department of Neurological and Psychiatric Sciences, Chair of Child Neuropsychiatry with the collaboration of the "Lapo"Association. It represents the first experience with a Master s Degree in TR on the world-wide level. It represents a fundamentally important stage in the national recognition of TR insofar as it confers a legally recognized title, officially utilizable. In fact, upon completion of the Master s Course there will be issued by the RECTOR of the UNIVERSITY of Florence and by the MASTER DIRECTOR a certificate of "MASTER in THERAPEUTIC RIDING" and starting next year it is very probable that there can be conferred the title of: TR TECHNICAL COORDINATOR. This will be the first official recognition in a professional TR profile on the national level, and one of the few on the international level. The University Master lasts one year (the next 2 years) and consists of 550 hours Director of the Master is Prof. Massimo Papini, Director of Chair of Child Neuropsychiatry (CNP) and of the University Post-Graduate School in Child Neuropsychiatry. Organizing Committee is costituted by Prof. Anna Pasquinelli (Coordinator), Dr. Paola Allori, (both Child Neuropsychiatrists); Dr.Barbara Montagnana (Physiatrist); PT Meike Susann Raupach. Objectives of the Master: providing the education and training in neurology, psychiatry, neuropsychology, rehabilitation, re-education and riding necessary to conduct TR, and furnishing the technical/practical skills required for multi-disciplinary integration. Aim of the Master: education/training professionals in TR in the specific field of their competences (medicine, social/health care, rehabilitation, education, etc.). Establishing the professional profile of: TR TECHNICAL COORDINATOR. Subject - matter of the Master: Social/health care, Rehabilitation and Education: Neurology, Psychiatry, Neuropsychology, Orthopedics, Neurosensorial Disorders, Rehabilitation. Therapeutic Riding: Hippotherapy, Remedial/Educational Riding, Vaulting, Sport Riding for the disabled. Equine Veterinary Science: ethology, anatomy, physiology, pathology, morphology, welfare; analysis of horse's movement in relation with his morphology and the different gaits. Riding: Techniques of riding and vaulting; driving; biomechanics of the horse; care of the horse. Organization and rules concerning the Equestrian Sports: Teachers and Services: Professors: Chair of CNP, Neurology, Psychiatry, Audiology, 6

7 Ophthalmology; Directors of Orthopaedy and Physiotherapy (PT) from the Polyclinic Hospital of Florence; CNP and PT Directors from the Local Health Services; Speech Therapists, Typhlology Specialists, Professional Educators; Therapists of TR Centers; Veterinarians; F.I.S.E. * Riding Instructors of 2nd and 3rd level, Federal Vaulting Instructors, F.I.S.E. National Riding Judges and International Riding Judges. Services for practical experience and training: Polyclinic Hospital of Florence: CNP Unit, Spinal Unit, Traumatologic Rehabilitation Services; Local Health Services: CNP Unit and Auxilia Laboratory; Center of Orthoepical Re-education; TR Centers (Florence, Montemurlo-Prato-, Aosta, Verona, Viterbo); F.I.S.E. Riding Center "La Querce", Montemurlo (Prato). Organization of Master : duration: one year (the next 2 years) for a total of 550 hours consisting of: a) Theoretical/practical activity: 400 hours (1 week of 40 hours a month for 10 months; location: Florence, Aosta, Viterbo, Verona (for Vaulting), organized by the Chair of Child Neuropsychiatry of the University of Florence, consisting of: - theoretical part: lessons, video analysis, seminars, stages; - practical part (training and practical experience) in the medical/rehabilitation/educational area, of riding and of TR at Riding Centers and TR Centers. b) Training in Therapeutic Riding : 150 hours, at accredited TR Centers. Requirements - Compulsory attendance - For the activity carried out at the TR Centers, site of Training (150 hours) the following is required: a) appointment of a Tutor by the TR Center site of Training b) management and assessment by the Tutor of the practical activity carried out, the elements and videorecording of which are to be reported in seminars and stages c) certificate of attendance and final assessment by the Director of the Therapeutic Riding Center; a final paper to be written on a case to be presented to the Examination Board. Theoretical/practical examinations in Neurology, Psychiatry, Neuropsychology, Rehabilitation, TR Rehabilitation, Veterinary, Riding, management and care of the horse will be held. Final Thesis consists in a written elaboration and oral discussion provided of an assembly of serial videorecordings relative to the follow up of a subject personally followed during the TR * FISE = Italian Equestrian Federation 7

8 training and of the evaluation of the results regarding the applied TR Neuromotor Disorders Disorders Assessment Scale (Pasquinelli et al, 1997, reviewed). Universitary Credits: 84 Pre-requisites for admission - A) Curriculum Requirements: - University Degree: in Medicine and Surgery, Motor Sciences, Education, Psychology, Sociology, or Veterinary Science. - University Diploma in one of the following areas: social/health care, rehabilitation and education or equivalent professions (Rehabilitation Therapist, Psychomotor Specialist, Orthoepical Specialist, Speech Therapist, Professional Educator, Nurse, Social Worker, etc.). - B) Horsemanship Requirements: good riding ability even not on competitive level comparable to a F.I.S.E. License. Number of partecipants: maximum 30 The multi-professional nature of the Courses and the Master s Degree has been dictated by the need to provide not only the education and training in neurology, psychiatry, neuropsychology, rehabilitation, re-education, veterinary science and riding necessary to conduct TR but also to furnish the technical/practical skills required for the multi-disciplinary integration requir ed for the Team Work characteristic of TR. SCIENTIFIC INITIATIVES OF THE CHAIR OF CHILD NEUROPSYCHIATRY A) The publication of the volume "Practical Principles of Therapeutic Riding" (Papini et Pasquinelli, 1996) accompanied by a 62-minute didactic videotape showing practical experiences for the professional application of the techniques of TR. The text is divided into three parts: the first regards "the world of the horse" seen from the perspective of TR; the second concerns the practical theoretical concepts of rehabilitation in general and of TR in child and adolescent affected by neuromotor and psychic pathology with particular attention to the methodology; the third part deals with the programs, the organization and the modalities of evaluation of the results. It represents nowadays for Italy an up-to-date technical tool of TR for TR Centers, Riding Centers and Sports The "TR Neuromotor Assessment Scale" examines: a) neuromotor modifications observed on horseback and long-term ones on the ground; b) possible modifications immediately following the TR session (within 20 minutes).this item serves to assess the difference in neuromotor capacity between the time just before mounting the horse and right after dismounting (within 20 minutes) c) acquired riding skills 8

9 Centers for the disabled, and a valid support for information and evaluation of TR in the general field of rehabilitation for institutions of Local Government and the National Health Service. We have distributed this publication and have sent it out to many University Professors, above all Neuropsychiatrists, Psychiatrists, Orthopedic Physisicians, Deans of Faculties, colleagues involved with Rehabilitation, Hospital Directors, Directors of the Health Care Services and Education Services, heads of public organisms (Regional Presidents, Mayors, Municipal and Regional Council men), Heads of FISE and FISD *, leading Riding Instructors etc. The result was a significant change in the attitudes of these professional vis-a-vis TR. It was also accompanied by the request on the part of university colleagues, especially Chi ld Neuropsychiatrists, to adopt the book for their lessons. B) Participation in national and international Congresses and Conferences. Equally important was the dissemination of information on a more personal level, through smaller and informal meetings held at the regional and municipal level or even at socialization centers, etc. C) Articles published in journals dealing with medicine, rehabilitation and sports. D) Contacts with Professional Associations and Orders, especially with the Medical Association. This was essential in order to make TR known by the Professionals who then directly refer their subjects to TR. The activity described above, the publication and diffusion of the book on the university level, especially among our medical colleagues (distributed free of charge to all of the Neuropsychiatrists of the University) and in particular, the Faculty of Medicine and Surgery of Florence, the wide-ranging activity of research with participation in Conferences and Symposiums on the international and above all the national level, the development of a strict methodology of application and verification based on an original Protocol for evaluating the results obtained on horseback and in particular on the ground afterwards, the relevant video documentation annexed to each production, the high professional level of the TR Centers which, through participation in the "Italian Study Group on TR" and the various training initiatives, has achieved notable improvement, has conferred credibility and important recognition of TR as a rehabilitation method also among structures such as the University, and in particular the Faculty of Medicine and Surgery of * FISD= Italian Sport Federation for the Disabled 9

10 Florence, which has consented to the establishing first (A.Y. 1999/2000, 2000/2001) of the "University Advanced Course in TR: Education/Training", then converted (A.Y. 2002/2003) into "University Master s Degree in TR". 10

11 REFERENCES Brown OJ, Tebay JM, Kluwer C (1994) - "Certification of Professionals in Therapeutic Riding: An International Perspective." In: Eaton PA (Ed) Proceed VIII Intern Therapeutic Riding Congr, Hamilton, New Zealand, January 17-20,. National Training Resource Centre, Levin, New Zealand: , Brown OJ, Tebay JM (1999) Therapeutic Riding Education: Professional Issues. Scientific and Educational J of Therapeutic Riding, 1999: Kluwer C, Shulz M (1997) Update on the therapeutic Riding content in University Curricula throughout the world. In: FRDI (Ed): Directory of Education and Training, 4 th Edition, Nolt B, Brown OJ, Spink J, Tebay JM (1994) - "Therapeutic Riding as a University Curriculum" In: Eaton PA (Ed): Proceed VIII Intern Therapeutic Riding Congr, Hamilton, New Zealand, January 17-20, National Training Resource Centre, Levin, New Zealand: Papini M (1996) Disabilità, Handicap e Riabilitazione. In: Papini M, Pasquinelli A (Eds): "Principi Pratici di Riabilitazione Equestre" UTET Periodici, Milano, 1996: Papini M, Pasquinelli A (1996) - "Principi Pratici di Riabilitazione Equestre" UTET Periodici, Milano. Pasquinelli A, Papini M (1997) Therapeutic Riding as a University Curriculum for Post- Graduate Physicians in Child Neurology and Psychiatry. In: Proceed IXth Intern Therapeutic Riding Congr "Riding the Winds of Progress" Denver, Co, USA, July 14-19, NAHRA Ed, Denver, USA: